Healthcare Provider Details

I. General information

NPI: 1174396899
Provider Name (Legal Business Name): CAMELIA EADDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 PEACHTREE RD NE STE 1250
ATLANTA GA
30326-1190
US

IV. Provider business mailing address

PO BOX 40412
BELFAST ME
04915-1255
US

V. Phone/Fax

Practice location:
  • Phone: 470-964-1700
  • Fax:
Mailing address:
  • Phone: 248-266-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN212698
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: